Eye Movement Desensitization and Reprocessing (EMDR) is an information processing psychotherapy that was developed to resolve symptoms resulting from disturbing and unresolved life experiences. EMDR is rated in the highest category of effectiveness and research support in international guidelines for PTSD treatment. It uses a structured approach to address past, present, and future aspects of disturbing memories. The approach was developed by Francine Shapiro to resolve symptoms resulting from exposure to a traumatic or distressing event, such as rape. Clinical trials have demonstrated EMDR's efficacy in the treatment of post-traumatic stress disorder (PTSD). In some studies it has been shown to be equivalent to cognitive behavioral and exposure therapies, and more effective than some alternative treatments (see effectiveness sections below). Although some clinicians may use EMDR for various problems, its research support is primarily for disorders stemming from distressing life experiences.
The theoretical model underlying EMDR treatment hypothesizes that EMDR works by processing distressing memories. EMDR is based on a theoretical information processing model which posits that symptoms arise when events are inadequately processed, and can be eradicated when the memory is fully processed. It is an integrative therapy, synthesizing elements of many traditional psychological orientations, such as psychodynamic, cognitive behavioral, experiential, physiological, and interpersonal therapies.
EMDR's most unique aspect is an unusual component of bilateral stimulation of the brain, such as eye movements, bilateral sound, or bilateral tactile stimulation coupled with cognitions, visualized images and body sensations. EMDR also utilizes dual attention awareness to allow the individual to vacillate between the traumatic material and the safety of the present moment. This prevents retraumatization from exposure to the disturbing memory. As EMDR is an integrative therapy which combines elements of cognitive behavioral and psychodynamic therapies to desensitize traumatic memories, some individuals have criticized EMDR and consider the use of eye movements to be an unnecessary component of treatment. However, recent studies have examined the effects of eye movements and have found that eye movements in EMDR decrease the vividness and/or negative emotions associated with autobiographical memories, enhance the retrieval of episodic memories, increase cognitive flexibility, and correlate with decreases in heart rate, skin conductance, and an increased finger temperature.
Description of therapy
Eye Movement Desensitization and Reprocessing (EMDR) has been used to treat posttraumatic stress disorder (PTSD). It integrates elements of imaginal exposure, cognitive therapy, psychodynamic and somatic therapies. It also uses the unique element of bilateral stimulation (e.g. moving the eyes back and forth). According to Francine Shapiro's theory, when a traumatic or distressing experience occurs, it may overwhelm usual ways of coping and the memory of the event is inadequately processed; the memory is dysfunctionally stored in an isolated memory network. When this memory network is activated, the individual may re-experience aspects of the original event, often resulting in inappropriate overreactions. This explains why people who have experienced or witnessed a traumatic incident may have recurring sensory flashbacks, thoughts, beliefs, or dreams. An unprocessed memory of a traumatic event can retain high levels of sensory and emotional intensity, even though many years may have passed.
EMDR uses a structured approach to address the past, present, and future aspects of the dysfunctionally stored memory. During the processing phases of EMDR, the client attends to the disturbing memory in multiple brief sets of about 15-30 seconds, while simultaneously focusing on the dual attention stimulus (e.g., therapist-directed lateral eye movements, alternate hand-tapping, or bilateral auditory tones). Following each set of such dual attention, the client is asked what associative information was elicited during the procedure. This new material usually becomes the focus of the next set. This process of alternating dual attention and personal association is repeated many times during the session.
The theory is that EMDR works directly with memory networks and enhances information processing by forging associations between the distressing memory and more adaptive information contained in other semantic memory networks. It is thought that the distressing memory is transformed when new connections are forged with more positive and realistic information. This results in a transformation of the emotional, sensory, and cognitive components of the memory so that, when it is accessed, the individual is no longer distressed. Instead he/she recalls the incident with a new perspective, new insight, resolution of the cognitive distortions, elimination of emotional distress, and relief of related physiological arousal.
Phases of treatment
Phase I: In the first sessions, the patient's history and an overall treatment plan are discussed. During this process the therapist identifies and clarifies potential targets for EMDR. Target refers to a disturbing issue, event, feeling, or memory for use as an initial focus for EMDR. Maladaptive beliefs are also identified.
Phase II: Before beginning EMDR for the first time, it is recommended that the client identify a safe place, an image or memory that elicits comfortable feelings and a positive sense of self. This safe place can be used later to bring closure to an incomplete session or to help a client tolerate a particularly upsetting session.
Phase III: In developing a target for EMDR, prior to beginning the eye movements, a snapshot image is identified that represents the target and the disturbance associated with it. Using that image is a way to help the client focus on the target, a negative cognition (NC) is identified - a negative statement about the self that feels especially true when the client focuses on the target image. A positive cognition (PC) is also identified - a positive self-statement that is preferable to the negative cognition.
Phase IV-VI: The therapist asks the patient to focus simultaneously on the image, the negative cognition, and the disturbing emotion or body sensation. Then the therapist usually asks the client to follow a moving object with his eyes; the object moves alternately from side to side so that the client's eyes also move back and forth. After a set of eye movements, the client is asked to report) the targeted memory.
Phase VII: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.
Phase VIII: Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses
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